Introduction & Scope
Female hair loss is multifactorial—genetic predisposition, hormonal shifts, nutritional deficiencies, and autoimmune causes contribute. This roadmap prioritizes accurate diagnosis and individualized treatment that respects pregnancy safety, fertility goals, and long-term hair health.
Differential Diagnosis in Women
Key diagnoses include female pattern hair loss (FPHL), telogen effluvium, alopecia areata, scarring alopecias, and traction alopecia. Diagnostic approach includes history of onset, pattern, lab work, trichoscopic signs, and, where indicated, scalp biopsy.
Evaluating Hormonal Drivers (PCOS, Thyroid, Menopause)
Screen for hormonal contributors with tests for TSH, free T4, total testosterone, SHBG, DHEAS, LH/FSH ratio, and androgen panels as indicated. PCOS management includes lifestyle, insulin-sensitizing strategies, and targeted medical therapy for hyperandrogenism.
Pregnancy & Postpartum Hair Changes
Pregnancy often increases hair fullness due to extended anagen; postpartum telogen effluvium is common within 3–6 months. Reassure patients about the typical timeline and focus on nutrition, sleep, and gentle hair care to support recovery.
Treatment Options & Safety in Women
Topicals (minoxidil) are first-line for many women, with caution around pregnancy/breastfeeding. Hormonal modulators like spironolactone are used off-label in select patients under monitoring. Procedural options (PRP, microneedling) are safe; systemic antiandrogens must be considered against reproductive plans.
Cosmetic and Concealer Strategies
Addressing immediate aesthetic concerns improves quality of life: tinted fibers, strategic styling, and volumizing products can be combined with long-term medical therapy to enhance patient confidence while regrowth takes effect.
