Female Pattern Hair Loss

Female pattern hair loss (FPHL) is a common, nonscarring hair-loss disorder that increases in prevalence with age, affecting up to 50% of women by age 70. Risk factors include genetics and endocrinological diseases. Diagnosis is clinical, with central scalp hair loss and follicle miniaturization, and can be differentiated from telogen effluvium through tests like the hair-pull test. First-line treatments include topical minoxidil and oral spironolactone, with second-line options such as oral minoxidil and finasteride. Treatment response takes 6 to 12 months and may initially cause shedding. FPHL has psychological impacts, warranting screening for anxiety and depression. Combining treatments can improve efficacy, and hair transplants are an option for nondiffuse hair loss. Most pharmacologic treatments are contraindicated in pregnancy.