Female Hair Loss: Causes, Evaluation, and Modern Treatments

Female hair loss (including androgenetic alopecia) often presents as diffuse thinning rather than complete baldness. Clinicians evaluate for thyroid disease, iron deficiency, hormonal causes, medications, and stress-related telogen effluvium. Treatments with evidence include topical minoxidil, oral antiandrogens, PRP, low-level laser therapy, and, for selected patients, hair transplantation, alongside cosmetic options and lifestyle interventions.

Overview

Hair thinning and increased shedding affect many women. Causes range from genetics and hormones to medical conditions, medications, nutritional gaps, and stress. The medical term for the most common pattern is androgenetic alopecia, often called female pattern hair loss.

How hair loss usually appears

Women typically notice diffuse thinning over the top and crown, rather than a single bald spot. Losing about 50-100 hairs a day is normal; a sustained increase in shedding or widening part lines suggests a problem.

Some causes are temporary. Telogen effluvium - a diffuse shedding that follows childbirth, significant illness, surgery, severe stress, or stopping hormonal contraception - usually starts 2-3 months after the trigger and often improves over several months. Other causes, such as androgenetic alopecia and thyroid disease, tend to be chronic without treatment.

Common causes to evaluate

• Androgenetic alopecia (female pattern hair loss), which has a strong genetic and hormonal component.

• Hormonal changes: menopause, pregnancy, and conditions with excess androgens such as polycystic ovary syndrome (PCOS).

• Thyroid disease and other systemic illnesses.

• Nutritional deficiencies (iron deficiency is common; low vitamin D or other deficiencies can contribute).

• Medications (some antidepressants, blood thinners, and more).

• Autoimmune conditions (for example, alopecia areata).

How doctors assess it

A dermatologist will take a history and examine your scalp. They may order lab tests such as TSH (thyroid), ferritin (iron stores), CBC, vitamin D, and androgen levels when signs point to hormonal excess. In some cases, a scalp biopsy or light-based imaging helps clarify the diagnosis.

Treatment options (what works now)

• Topical minoxidil: the only widely recommended topical treatment with consistent evidence for female pattern hair loss. It can take several months to show improvement.

• Oral antiandrogens: spironolactone is commonly used off-label for women with signs of androgen excess; finasteride is sometimes used in postmenopausal women but is not appropriate during pregnancy.

• Procedural options: platelet-rich plasma (PRP) injections and low-level laser devices have growing evidence and are offered by specialists.

• Hair transplantation: effective for selected women with stable, localized hair loss but may be less suitable for diffuse thinning.

• Cosmetic approaches: topical concealers, hair fibers, extensions, and wigs provide immediate improvement in appearance.

When to see a specialist

See a dermatologist when shedding is sudden, severe, accompanied by scalp inflammation or pain, or when cosmetic impact causes distress. Early evaluation improves chances of identifying reversible causes and starting effective therapy.