Female Pattern Hair Loss and Androgen Excess: A Report From the Multidisciplinary Androgen Excess and PCOS Committee

J Clin Endocrinol Metab. 2019 Jul 1;104(7):2875-2891. doi: 10.1210/jc.2018-02548.


Objective: To determine the current state of knowledge and provide evidence-based recommendations that could be valid for all specialists taking care of female pattern hair loss (FPHL), a common form of hair loss in women that is characterized by the reduction of hair density in the central area of the scalp, whereas the frontal hairline is generally well conserved.

Participants: An expert task force appointed by the Androgen Excess and PCOS Society, which included specialists from dermatology, endocrinology, and reproductive endocrinology.

Design: Levels of evidence were assessed and graded from A to D. Peer-reviewed studies evaluating FPHL published through December 2017 were reviewed. Criteria for inclusion/exclusion of the published papers were agreed on by at least two reviewers in each area and arbitrated by a third when necessary.

Conclusions: (i) The term "female pattern hair loss" should be used, avoiding the previous terms of alopecia or androgenetic alopecia. (ii) The two typical patterns of hair loss in FPHL are centrifugal expansion in the mid scalp, and a frontal accentuation or Christmas tree pattern. (iii) Isolated FPHL should not be considered a sign of hyperandrogenism when androgen levels are normal. (iv) The assessment of patients with FPHL is primarily clinical. (v) In all patients with FPHL, assessment of a possible androgen excess is mandatory. Measurement of vitamin D, iron, zinc, thyroid hormones, and prolactin are optional but recommended. (vi) Treatment of FPHL should start with minoxidil (5%), adding 5α-reductase inhibitors or antiandrogens when there is severe hair loss or hyperandrogenism.

Publication types

  • Meta-Analysis
  • Practice Guideline
  • Systematic Review

MeSH terms

  • 5-alpha Reductase Inhibitors / therapeutic use
  • Alopecia / diagnosis*
  • Alopecia / epidemiology
  • Alopecia / pathology
  • Alopecia / therapy
  • Androgen Antagonists / therapeutic use
  • Female
  • Humans
  • Hyperandrogenism / diagnosis*
  • Hyperandrogenism / drug therapy
  • Hyperandrogenism / epidemiology
  • Hyperandrogenism / metabolism
  • Low-Level Light Therapy
  • Mineralocorticoid Receptor Antagonists / therapeutic use
  • Minoxidil / therapeutic use
  • Platelet-Rich Plasma
  • Polycystic Ovary Syndrome / epidemiology
  • Polycystic Ovary Syndrome / metabolism
  • Scalp / pathology
  • Spironolactone / therapeutic use
  • Vasodilator Agents / therapeutic use


  • 5-alpha Reductase Inhibitors
  • Androgen Antagonists
  • Mineralocorticoid Receptor Antagonists
  • Vasodilator Agents
  • Spironolactone
  • Minoxidil