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2693 pages added, reviewed or updated during the last month (last updated: 14/4/2021)

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female pattern hair loss (FPHL)

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Female pattern hair loss is a common condition characterized by a diffuse reduction in hair density over the crown and frontal scalp with retention of the frontal hairline.

  • FPHL is now the preferred term for androgenic alopecia (AGA) in women (1)
  • the prevalence and severity increases with advancing age (2)
    • prevalence in the UK and USA studies in Caucasian women show similar frequencies, increasing from 3% to 6% in women aged under 30 years to 29 to 42% in women aged 70 and over
    • oriental women have a lower frequency of androgenetic alopecia than women of European origin (2)

The exact aetiology of female pattern hair loss (FPHL) is not known

  • there is a progressive miniaturization of hairs, resulting in loss of hair density and widening of the midline part clinically
  • in contrast to male-pattern hair loss, the androgenic nature of FPHL is not clear and women often have normal hormonal profiles and no other signs of androgenization
  • hypothesized that FPHL has a polygenetic mode of transmission
    • it is thought that early- and late-onset female AGA are genetically distinct (2)

Most women present with a history of gradual thinning of scalp hair, often over a period of several years

  • hair loss can start at any time between early teens and late middle age - however hair loss may precede pubarche and menarche (1)
  • frequently a history of excessive hair shedding, but unlike telogen effluvium, hair thinning is usually noticed from the outset

Pattern of hair loss

  • examination of the scalp shows three different patterns:
    • diffuse thinning of the crown region with preservation of the frontal hairline - two scales can be used to describe this pattern
      • the commonly used 3-point Ludwig scale
      • the 5-point Sinclair scale
    • thinning and widening of the central part of the scalp with breach of frontal hairline (christmas tree pattern) - assessed by Olsen scale
    • thinning associated with bitemporal recession - Hamilton-Norwood type (2)
  • in some women the hair loss may affect a quite small area of the frontal scalp whereas in others the entire scalp is involved, including the parietal and occipital regions
  • although many women develop a minor degree of postpubertal recession at the temples whether or not they have diffuse hair loss


  • usually straightforward but other causes of diffuse hair loss may need to be excluded, particularly when the hair loss progresses rapidly
    • occasionally, systemic lupus erythematosus can also present in this way
    • in alopecia areata there may be hair loss in other sites
    • hypothyroidism is also in the differential


  • antiandrogens and topical minoxidil have been used in the management of this condition (3)


Last reviewed 01/2018