Patient Information

Female Pattern Hair Loss

Female pattern hair loss (FPHL) is a common form of chronic hair loss in women. It is a progressive condition typically characterised by diffuse thinning over the crown and mid-scalp, with preservation of the frontal hairline in many cases (Ramos & Miot, 2015).

Although female pattern hair loss has historically been grouped under the term androgenetic alopecia, androgen activity in women is more variable than in men. Many affected women have normal circulating androgen levels; “female pattern hair loss” is therefore commonly used as the clinical term (Olsen, 2001).

This page provides general information about FPHL, other causes of diffuse shedding, and management options. It is for educational purposes only and does not constitute medical advice. Treatment decisions require an individual assessment by a registered medical practitioner.

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Female Pattern Hair Loss Diagram

Male and Female Pattern Hair Loss

Both male and female pattern hair loss involve follicular miniaturisation, in which successive hair cycles produce progressively finer hairs. Their distribution and hormonal context differ.

Distribution & Hormones

Distribution: Women commonly develop diffuse central thinning and widening of the midline parting, often with preservation of the frontal hairline; men more commonly develop bitemporal recession and vertex thinning.

Hormonal contribution: Dihydrotestosterone has an established role in male pattern hair loss. In FPHL, androgen contribution is less consistent, and normal serum androgen levels do not exclude the diagnosis.

Progression & Staging

Progression: FPHL usually progresses gradually. Complete scalp baldness is uncommon.

The Ludwig scale (Types I–III) is commonly used to describe the severity of FPHL (Ludwig, 1977).

Aetiology and Related Factors

FPHL is multifactorial. Potentially relevant factors include:

Illustration of female hair loss patterns and follicular structure

Telogen Effluvium

Telogen effluvium (TE) is a common cause of acute or subacute diffuse shedding in women. It may be distinct from FPHL, although the two conditions can coexist.

The normal hair cycle comprises anagen (growth), catagen (transition), and telogen (resting) phases. In TE, a higher proportion of follicles shifts prematurely into telogen, causing diffuse shedding. The shedding often becomes apparent two to four months after a trigger and may improve when the trigger is addressed (Malkud, 2015).

Reported Triggers

FPHL and Telogen Effluvium Comparison

Feature Female Pattern Hair Loss Telogen Effluvium
Distribution Central scalp thinning or widening parting Diffuse shedding across the scalp
Onset Gradual and progressive Subacute, often two to four months after a trigger
Course Chronic; usually not spontaneously reversible Often improves after the trigger is addressed
Trichoscopy Hair-shaft diameter variation and miniaturisation may be present May show increased telogen shedding without the typical pattern of miniaturisation

Clinical Assessment

Assessment may include:

  • Medical, obstetric, menstrual, menopausal, medication, dietary, stress, and family history.
  • Scalp and hair examination, including Ludwig staging.
  • Trichoscopy, where indicated, to document density, hair-shaft diameter variation, and miniaturisation.
  • Pull test or examination of shed hairs where clinically relevant.
  • Targeted blood tests when history or examination suggests nutritional, endocrine, or systemic contributors.

Accurate diagnosis is important because management differs between FPHL, TE, and other causes of hair loss.

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Management Options

The following describes possible approaches and their evidence base. Individual suitability, expected benefit, risks, and need for medical supervision differ between patients. No intervention guarantees a particular outcome.

Other Management Options & General Health

  • Antiandrogen and 5-Alpha Reductase Inhibitor Therapy

    Use of finasteride in women is more nuanced than in men and is generally considered only in selected clinical settings, such as some postmenopausal patients. Finasteride and related 5-alpha reductase inhibitors are contraindicated in pregnancy because of fetal risk; counselling and effective contraception are essential when relevant.

  • Hair Transplantation

    Hair transplantation relocates follicular units, usually from the occipital donor area, to areas of thinning. In women, suitability depends on disease stability, donor density, hair-loss distribution, and future hair-loss trajectory. Risks include bleeding, infection, scarring, and variable graft survival.

  • Scalp Micropigmentation

    Scalp micropigmentation (SMP) is a cosmetic camouflage technique that deposits pigment in the superficial scalp dermis to reduce contrast between scalp and existing hair or create an appearance of density. It does not regrow hair.

  • Holistic Hair and Scalp Wellness Programme

    Personalised care combining assessment, appropriate investigations, scalp care, and lifestyle guidance to support long-term scalp health and address early hair thinning or shedding.

  • General Scalp and Hair Health

    • Maintain adequate dietary protein and address identified nutritional deficiency under clinical guidance.

    • Avoid excessive chemical or traction-related hair practices.

    • Seek medical assessment for progressive loss, acute diffuse shedding, scalp symptoms, or signs of androgen excess.

References & Further Information

If you are concerned about hair loss, consult a registered medical practitioner for an individual assessment. This page is for general education only and does not constitute medical advice, diagnosis, or treatment recommendation.

References

  • Alessandrini AM, Bruni F, Piraccini BM, Starace M. The effectiveness and tolerability of preformed growth factors vehiculated through iontophoresis on patients with androgenetic alopecia and telogen effluvium: A clinical study. Dermatology Practical & Conceptual. 2021;11(3):e2021082. doi:10.5826/dpc.1103a82.
  • Avci P, Gupta GK, Clark J, Wikonkal N, Hamblin MR. Low-level laser (light) therapy (LLLT) for treatment of hair loss. Lasers in Surgery and Medicine. 2014;46(2):144–151.
  • Cedirian S, Pampaloni F, Quadrelli F, et al. Efficacy of skin patting and iontophoresis with dutasteride gel in male and menopausal female androgenetic alopecia: A pilot study. Dermatology and Therapy. 2025;15(11):3419–3424. doi:10.1007/s13555-025-01532-w.
  • Jimenez JJ, Wikramanayake TC, Bergfeld W, et al. Efficacy and safety of a low-level laser device in the treatment of male and female pattern hair loss: A multicenter, randomized, sham device-controlled, double-blind study. American Journal of Clinical Dermatology. 2014;15(2):115–127.
  • Lucky AW, Piacquadio DJ, Ditre CM, et al. A randomized, placebo-controlled trial of 5% and 2% topical minoxidil solutions in the treatment of female pattern hair loss. Journal of the American Academy of Dermatology. 2004;50(4):541–553.
  • Ludwig E. Classification of the types of androgenetic alopecia (common baldness) occurring in the female sex. British Journal of Dermatology. 1977;97(3):247–254.
  • Malkud S. Telogen effluvium: A review. Journal of Clinical and Diagnostic Research. 2015;9(9):WE01–WE03.
  • Olsen EA. Female pattern hair loss. Journal of the American Academy of Dermatology. 2001;45(3 Suppl):S70–S80.
  • Ramos PM, Miot HA. Female pattern hair loss: A clinical and pathophysiological review. Anais Brasileiros de Dermatologia. 2015;90(4):529–543.

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This page is intended for general educational purposes only. It does not constitute medical advice, diagnosis, or treatment recommendation, and does not create a doctor–patient relationship. For assessment of your individual condition, please consult a registered medical practitioner.