Androgenetic Alopecia in Women: A Narrative Review of Pathophysiology, Clinical Evaluation, and Treatments

Autores de IIS La Fe

• Miguel Antonio Lasheras Pérez

  Autor

Participantes ajenos a IIS La Fe

• Kearney, C.A.
• Brinks, A.L.
• Lawrence, C.N.
• Maas, D.E.
• Spindler, A.J.
• Coric, C.
• Shapiro, J.
• Lo-Sicco, K.I.

Grupos

• Dermatología y Regeneración Tisular

Abstract

Androgenetic alopecia (AGA) affects nearly 50% of women during their lifetime, representing the most prevalent form of chronic hair loss in this population. Despite its high incidence, AGA in women remains underdiagnosed and undertreated, with significant psychosocial consequences including diminished self-esteem, impaired social functioning, and reduced quality of life that often exceed impacts observed in men. AGA pathophysiology involves complex interactions between hormonal, genetic, and environmental factors. Androgens promote follicular miniaturization through progressive shortening of the anagen phase, while estrogens may provide protective effects. Genetic studies reveal sex-specific differences in disease mechanisms, and environmental factors like oxidative stress and pollution may contribute to disease progression. Clinical evaluation requires careful consideration of differential diagnoses including chronic telogen effluvium, diffuse alopecia areata, and scarring alopecias. Diagnostic tools include trichoscopy, pull testing, and trichometric measurements to assess hair density and miniaturization patterns. Currently, topical minoxidil is the only FDA-approved treatment for female AGA, also referred to as female pattern hair loss (FPHL). Off-label therapies include low-dose oral minoxidil, anti-androgens such as spironolactone and 5-alpha reductase inhibitors (finasteride and dutasteride), and hair transplantation. Adjunctive treatments like low-level light therapy and platelet-rich plasma may further augment improvement and are often best used in conjunction with medical therapies. Critical research gaps persist, including the paucity of randomized controlled trials for AGA that include female patients. There is an urgent need for additional FDA-approved therapies for AGA in women to increase treatment access and reduce its psychosocial burden. © The Author(s), under exclusive licence to Springer Nature Switzerland AG 2026.

Keywords

• androgen; antiandrogen; dutasteride; estrogen; finasteride; minoxidil; spironolactone; steroid 5alpha reductase inhibitor; access to treatment; adult; alopecia areata; androgenetic alopecia; clinical evaluation; diagnosis; differential diagnosis; diffuse alopecia; drug therapy; environmental factor; female; female pattern hair loss; Food and Drug Administration; hair growth; hair loss; hair transplantation; human; low drug dose; low level laser therapy; male; mental stress; miniaturization; off label drug use; oxidative stress; pathophysiology; quality of life; randomized controlled trial; review; scarring alopecia; self esteem; social interaction; telogen effluvium; therapy; thrombocyte rich plasma; topical drug administration; trichoscopy