Evidence-based treatments that can be used for female pattern alopecia by a trichologist.

*This is not medical advise- people should only use theses therapies under the individual care of their Trichologist or GP.

Trichologists have a unique opportunity provide a wide range of therapies to our patients dealing with female pattern hair loss (FPHL), but also to help them navigate their way to other treatment pathways that may fall outside a Trichologists scope of practice, such as, prescription pharmaceuticals or hair transplantation.

With approximately 50% of women experiencing the onset of FPHL by the age of 60 (Ring et al., 2022), having an array of efficacious treatment modalities is increasingly important, to provide our patients with a suitable treatment plan for their unique set of circumstances. Accommodating what they feel comfortable taking (medications/supplements), applying topically, and financially committing to.

I believe that part of the invaluable service a Trichologist can provide to their patient is education about these different modalities, and a guiding hand to what we believe, as an educated expert, to best suit their unique circumstances.

In FPHL, genetic susceptibility allows hair follicles in the central-parietal region of the scalp, to be sensitive to DHT. This, paired with the peri-follicular inflammation, causes the hair follicles to experience miniaturization, leading to the appearance of thinning over time.

Below I will go through therapies a Trichologist can personally provide to a patient managing FPHL.

Topical minoxidil 5% has been long been regarded as one of the most efficacious treatments for FPHL and continues to provide good outcomes to many patients with minimal side effects. The FDA approved foam vehicles of topical 5% minoxidil for the treatment of FPHL in 2014 (Müller Ramos et al., 2023).  

In many countries, including Australia, 5% topical minoxidil is available without a prescription and is therefore one of the most efficacious treatments a Trichologist can recommend to a patient.

The mechanisms by which minoxidil aids in the treatment of FPHL are not fully understood. It is thought to work via multiple mechanisms including arteriolar vasodilation through action on ATP gated smooth muscle K+ channels. Upregulating Wnt/beta-catenin signalling by increasing vascular endothelial growth factor (VEGF) levels and, has shown to reduce pro-inflammatory cytokines that may play a role in FPHL (Kaiser et al., 2023).

The general guidelines for application are- 5% topical foam/lotion, half a cap of foam or 1ml of lotion, once daily on effected zones.

After starting topical minoxidil, many patients report an initial increase in hair shedding, which can last up to 3 months before correcting (Iyengar & Li, 2025).

Oral or sublingual minoxidil, usually prescribed at 0.25-1mg compounded tablets (off-label), once daily, is fast becoming popular among dermatologists and patients who don’t like/can’t applying lotions or foams to their scalp (Randolph & Tosti, 2021).

Therefore, oral minoxidil is an efficacious therapy Trichologists can guide patients towards with non-compliance to topical options or a preference for non-topical treatment.

Low Level laser therapy (LLLT) has been used in dermatology to reduce inflammation and promote wound healing. As a treatment for FPHL, it is considered relatively new. In 2018 the FDA approved LLLT for the therapy of androgenetic alopecia, and with recent studies showing good results, it is quickly becoming a first line treatment option due to its minimally invasive and cost-effective nature. 

LLLT involves a device that topical exposes the affected regions to light wavelengths between 600 and 1,100 nm, usually 650-900nm for AGA. It is typically provided by home-use devices in the form of combs, caps, and helmets. In studies, minimal side effects have been reported, contributing to its growing popularity in therapy (Kaiser et al., 2023; Nestor et al., 2021).

LLLT is thought to promote hair growth by facilitating anagen re-entry of telogen follicles, elongating the anagen phase, and preventing premature conversion from anagen to catagen. It is thought to do this through upregulation of endogenous growth factors and nitric oxide leading to cellular proliferation and vasodilation (Devjani et al., 2023).

Some studies are suggesting LLLT may even be more efficacious than topical minoxidil and treatment with LLLT and minoxidil concurrently may be more effective than monotherapy. However, this needs to be further validated by more randomised control studies (Kaiser et al., 2023).

LED devices, emitting light between 620-660nm, have also been found helpful in the treatment of FPHL.

While topical minoxidil LLLT are the only FDA approved treatments for FPHL, they are just a fraction of the potential treatment modalities available (Nestor et al., 2021).

Nutraceuticals are a developing area of therapy for FPHL. Some recent studies are showing promising results with blends comprised of phytoactive extracts, vitamins, and minerals, that have mechanisms to inhibit 5-alpha-reductase, reduce inflammation, lower cortisol levels, promote homeostasis, and maintain collagen stores.

Studies surrounding nutraceuticals include ones looking at the Synergen complex (Nutrafol), Marine complex (Viviscal), and ALRV5XR (Replenology) (Nestor et al., 2021; Feldman et al., 2021; Ring et al., 2022; Ablon & Kogan, 2021).

One systemic review looked at 30 nutritional intervention studies and found the following complexes to have the most evidence supporting efficacy- Viviscal, Nourkrin, Nutrafol, Lamdapil, Pantogar, Capsaicin and isoflavone, omega 3 and 6 with antioxidants, apple nutraceutical, total glucosides of paeony and compound glycyrrhizin tablets, zinc, tocotrienol, and pumpkin seed oil (Drake et al., 2022).

Saw palmetto, the botanical extract from Serenoa Repens berries, is a competitive, nonselective inhibitor of both 5-alpha-reductase isoforms. It can block the uptake of DHT and decreases DHT binding capacity to androgen receptors by nearly 50%. It may also help convert DHT to the weaker hormone, androstanediol by increasing 3α-hydroxysteroid-dehydrogenase, and has shown to potentially have anti-inflammatory benefits on keratinocytes. Saw palmetto has a minimal side-effect profile, low drug interaction potential, and with no current regulations advising against using it in women post-menopause or of fertile age, and studies including women reporting no adverse effects independent to the male groups, it is becoming a popular natural alternative in combination with other therapies. However, due to a lack of high-quality studies, many current studies investigating it in blends with other nutraceuticals, rather than isolated, and mechanisms acting similarly to pharmaceutical 5-alpha-reductase inhibitors, ceasing use prior to conceiving is recommended.

Saw palmetto is just one of the emerging plant-derived DHT blockers (Evron et al., 2020; Sudeep et al., 2023).

Microneedling is a minimally invasive treatment, whereby, small needles puncture the skin. Studies have revealed it to be a safe and effective adjunct treatment for FPHL. The micro trauma has been shown to release platelet-derived growth factors, dermal-papilla stem cells, VEGF, promote collagen formation, and enhance absorption of topical therapies through microchannels in the skin. These factors promote angiogenesis, wound healing, and reverse fibrosis. One study suggests that a needle depth of 0.6mm is a more effective choice than 1.2mm. A review on 17 clinical studies with 911 participants with AGA, revealed improvement in hair parameters when used in conjunction with 5% topical minoxidil and/or PRP. Frequency of treatment varies depending on the patient and other treatments, and patients should be cautious of infection and overuse.

Topical caffeine can aid FPHL via increasing cyclic adenosine monophosphate and cellular metabolism, triggering cellular proliferation that helps reverse miniaturisation. Female hair follicles also appear to be less resistant to caffeine in comparison to males.

One small study showed Rosemary oil to increase hair counts after 6 months of treatment. The active ingredients caffeic acid, rosmarinic acid, camphor, and 12-methoxycarnosic acid work to enhance microcapillary perfusion, increase prostaglandin E2 production, and decrease leukotriene B4 production, which can reduce inflammation, stimulate growth, and fight infection (Nestor et al., 2021; Devjani et al., 2023).

Patients with FPHL may use shampoo containing 2% ketoconazole, in addition to other treatments, as it has been seen to increase hair diameter in patients with AGA. Topical melatonin is another worthy mention in treatment of FPHL (Fields et al., 2020; Babadjouni et al., 2023).

Depending on a Trichologists qualifications and/or area of practice in the world, they may additionally be able to provide treatments such as platelet-rich-plasma, exosomes, or trans epidermal delivery of growth serums.

To summarise, there are a myriad of different efficacious treatment modalities a Trichologist can recommend for FPHL, and this doesn’t even touch on the importance of a customised clinical consultation involving reviewing patient’s medical history, blood tests, and lifestyle factors to ensure optimal levels of nutrients and balance of hormones to support hair growth/follicle immune privilege/inflammation. Or dietary and lifestyle factors that could be contributing to increase stress/inflammation.   

References

Ablon, J., & Kogan, S. (2021). A Randomized, Double-Blind, Placebo-Controlled Study of a Nutraceutical Supplement for Promoting Hair Growth in Perimenopausal, Menopausal, and Postmenopausal Women With Thinning Hair. Journal of Drugs in Dermatology, Volume 20,(1). https://jddonline.com/articles/a-randomized-double-blind-placebo-controlled-study-of-a-nutraceutical-supplement-for-promoting-hair-S1545961621P0055X/

Babadjouni, A., Reddy, M., Zhang, R., Raffi, J., Phong, C. H., & Mesinkovska, N. A. (2023). Melatonin and the Human Hair Follicle. Journal of Drugs in Dermatology, 22(3), 260–264. https://doi.org/10.36849/jdd.6921

Devjani, S., Ezemma, O., Kelley, K. J., Stratton, E., & Senna, M. (2023). Androgenetic Alopecia: Therapy Update. Drugs, 83(8), 701–715. https://doi.org/10.1007/s40265-023-01880-x 

Drake, L., Reyes-Hadsall, S., Martinez, J., Heinrich, C., Huang, K., & Mostaghimi, A. (2022). Evaluation of the Safety and Effectiveness of Nutritional Supplements for Treating Hair Loss. JAMA Dermatology, 159(1), 79-86. https://doi.org/10.1001/jamadermatol.2022.4867

Evron, E., Juhasz, M., Babadjouni, A., & Mesinkovska, N. A. (2020). Natural hair supplement: Friend or foe? Saw palmetto, a systematic review in alopecia. Skin Appendage Disorders, 6(6), 1–9. https://doi.org/10.1159/000509905

Feldman, P. R., Fiebig, K. M., Piwko, C., Mints, B. M., Brown, D., Cahan, D. J., & Guevara-Aguirre, J. (2021). Safety and efficacy of ALRV5XR in women with androgenetic alopecia or telogen effluvium: A randomised, double-blinded, placebo-controlled clinical trial. EClinicalMedicine, 37, 100978. https://doi.org/10.1016/j.eclinm.2021.100978

Fields, J. R., Vonu, P. M., Monir, R. L., & Schoch, J. J. (2020). Topical ketoconazole for the treatment of androgenetic alopecia: A systematic review. Dermatologic Therapy, 33(1). https://doi.org/10.1111/dth.13202

Iyengar, L., & Li, J. (2025). Male and female pattern hair loss. Australian Prescriber, 48(3), 93–97. https://doi.org/10.18773/austprescr.2025.020 

Kaiser, M., Abdin, R., Gaumond, S. I., Issa, N. T., & Jimenez, J. J. (2023). Treatment of Androgenetic Alopecia: Current Guidance and Unmet Needs. Clinical, Cosmetic and Investigational Dermatology, Volume 16, 1387–1406. https://doi.org/10.2147/ccid.s385861

Müller Ramos, P., Melo, D. F., Radwanski, H., de Almeida, R. F. C., & Miot, H. A. (2023). Female pattern hair loss: therapeutic update. Anais Brasileiros de Dermatologia, 98(4). https://doi.org/10.1016/j.abd.2022.09.006 

Nestor, M. S., Ablon, G., Gade, A., Han, H., & Fischer, D. L. (2021). Treatment options for androgenetic alopecia: Efficacy, side effects, compliance, financial considerations, and ethics. Journal of Cosmetic Dermatology, 20(12). https://doi.org/10.1111/jocd.14537

Randolph, M., & Tosti, A. (2021). Oral minoxidil treatment for hair loss: A review of efficacy and safety. Journal of the American Academy of Dermatology, 84(3). https://doi.org/10.1016/j.jaad.2020.06.1009

Ring, C., Heitmiller, K., Correia, E., Gabriel, Z., & Saedi, N. (2022). Nutraceuticals for Androgenetic Alopecia. The Journal of Clinical and Aesthetic Dermatology, 15(3), 26-29. https://pmc.ncbi.nlm.nih.gov/articles/PMC8944288/ 

Sudeep, H. V., Rashmi, S., Jestin, T. V., Richards, A., Gouthamchandra, K., & Shyamprasad, K. (2023). Oral and Topical Administration of a Standardized Saw Palmetto Oil Reduces Hair Fall and Improves the Hair Growth in Androgenetic Alopecia Subjects – A 16-Week Randomized, Placebo-Controlled Study. Clinical, Cosmetic and Investigational Dermatology, Volume 16, 3251–3266. https://doi.org/10.2147/ccid.s435795