Female Hair Loss – What Causes It?

Our understanding of the pathogenesis of Female Pattern Hair Loss (FPHL) is still incomplete, and there’s ongoing debate over the role of androgens. Some researchers and clinicians argue that FPHL should not be strictly classified as Female Androgenetic Alopecia (FAGA) because, unlike in men, the direct link between DHT and follicular miniaturization in women is less clear. Here are some key points in the controversy:

1. Role of Androgens: 

a) Women with hyperandrogenism (e.g., PCOS) often experience hair loss, suggesting a role for androgens.

b) However, many women with FPHL have normal androgen levels, making some question whether androgens are the primary driver. c) Testosterone supplementation can accelerate hair loss in androgen-sensitive women, reinforcing the idea that even low androgen levels can trigger FPHL in susceptible individuals. 4

2. ) Finasteride & Dutasteride Efficacy:

a) Finasteride 5 mg daily has shown efficacy in treating FPHL, which implies that androgens may still play a role.

b)  Dutasteride, which is a more potent 5alpha-reductase inhibitor, has also been used in some cases with success.

c) The fact that Finasteride is now being explored for Lichen Planopilaris (LPP) and Frontal Fibrosing Alopecia (FFA) suggests it may have anti-inflammatory or other mechanisms beyond just DHT inhibition.

Ultimately, FPHL appears to be a multifactorial condition rather than purely androgen-driven, which explains why treatments like minoxidil, PRP, exosomes, or laser therapy can still benefit patients even when they don’t directly address androgens.

Dr. Ron Shapiro contributed the above post. 

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