FPHL is the most common type of hair loss in women.

What is female pattern hair loss?

Female pattern baldness is the most common type of hair loss in women. Female pattern hair loss (FPHL) is a distinctive form of hair loss that occurs in women with androgenetic alopecia. Many women are affected by FPHL. In fact, about 40% of women at the age of 50 show signs of hair loss and less than 45% of women reach the age of 80 with full hair.

FPHL has a strong genetic predisposition. The mode of inheritance is polygenic, indicating that there are many genes that contribute to FPHL, and these genes could be inherited from either parent, or both. Genetic testing to assess risk of balding is currently not recommended, as it is unreliable.

Hair loss in women

What causes female pattern hair loss?

Each strand of hair, called follicle, is found in a small hole (cavity) in the skin. In general, baldness occurs when the hair follicle shrinks over time, resulting in shorter and thinner hair. Eventually, no new hair grows in the follicle, however, the follicles remain alive, suggesting that it is still possible to develop new hair.

The pattern of female pattern baldness is not well understood, but may be related to:

  • Aging
  • Changes in androgen levels (male hormones). For example, after reaching menopause, many women find that the hair on their head is thinner, while the hair on their face is thicker.
  • Family history of male or female pattern baldness.


Thinning hair is different from male pattern baldness. In female pattern baldness:

  • The hair thins mainly on the top and the crown. It usually begins with a widening through the central part of the hair.
  • The front line of the hair is not affected, except by a normal recession, which happens to everyone as we get older.
  • Hair loss rarely progresses to total or near-total baldness, as can occur in men.

The Ludwig Scale (Female Pattern)

The Ludwig Scale or Female Pattern was developed by Dr. Ludwig. The difference between the male pattern is that it is divided in only 3 degrees and in very rare cases we find 2 degrees more.

Grade I: Baldness in this phase is classified as mild and its presence is not evident in the hairline.

Grade II: Here there is a greater weakening of the hair passing this to a finer degree, the affected area is located in the part of the crown.

Grade III: We have a so-called extensive baldness and is present throughout the upper area, with the crown being the most affected part.

Grado IV: Hair loss is more diffuse and a frontotemporal recession occurs.

Grado V: We are in a total hair loss being more similar to the male pattern.

What are the effects of hair loss in women?

Many studies have shown that hair loss in women is not simply a cosmetic problem, but also causes great psychological distress. Compared to unaffected women, those affected have a more negative body image and are less able to cope with daily functioning. Hair loss can be associated with low self-esteem, depression, introversion and feelings of lack of attractiveness. It is especially difficult to live in a society that values youthful appearance and attractiveness.

What treatments are available?

The only medication approved by the United States Food and Drug Administration (FDA) to treat female pattern baldness is minoxidil:

  • It is applied to the scalp.
  • For women, the 2% or 5% foam solution is recommended.
  • Minoxidil can help hair grow in about 1 in 4 or 5 women. In most women, it can slow or stop hair loss.
  • You must continue using this medication for a long time. Hair loss starts again when you stop using it. In addition, the hair that minoxidil has helped grow will fall.

Hormone treatment, that is, oral medications that block the effects of androgens (eg, spironolactone, cyproterone, finasteride and flutamide) are also often used.

It has been shown that a combination of low doses of oral minoxidil (0.25 mg daily) and spironolactone (25 mg daily) significantly improves hair growth, reduces shedding and improves hair density.

The cosmetic camouflages include colored hair sprays to cover thinning areas on the scalp, fiber powder for the hair and hair wigs.

In a woman suffering from FPHL, if medical causes have been ruled out, hair transplantation becomes the final treatment. Hair transplantation for FPHL is increasingly popular.

Who are the possible candidates for hair transplantation?

  • Women who have suffered hair loss due to mechanical or traction alopecia (non-hormonal)
  • Women who have had previous cosmetic or plastic surgery and are worried about hair loss around the incision sites.
  • Women who have a different pattern of baldness, similar to male pattern baldness. This includes, capillary recession, thinning of the vertices and a donor area that is not affected by androgenetic alopecia.
  • Women who suffer hair loss due to trauma, including burn victims, scars caused by accidents and chemical burns.
  • Women with marginal alopecia, a condition that looks very similar to traction alopecia.