Hair loss in women: causes, PCOS, tests and treatments

The most common cause of hair loss in women is female pattern hair loss, but other causes can look a lot like it and need different treatment [3]. This page goes through the common causes and how each one looks, hair loss with PCOS, the tests a doctor may do, when to go soon, and what the treatments can do. Every medical statement links to one of 15 sources (dermatology and NHS patient pages, the international PCOS guideline, reviews and a drug label), quoted at the bottom. For hair loss in general, in men and women, and how much shedding is normal: hair loss: causes and what’s normal.

In short: the most common cause is female pattern hair loss: gradual thinning on top with a wider part, while the hairline stays. Heavy shedding a few months after childbirth, an illness, surgery or losing a lot of weight is usually temporary. Round bald patches, a receding band at the front with thinning eyebrows, or a sore or itchy scalp need a dermatologist soon, because hair lost to scarring does not come back. A doctor will usually look for signs of too many androgens (as in PCOS) and may check iron and thyroid. Minoxidil is the approved treatment; spironolactone and low-dose oral minoxidil are used off-label.

What causes hair loss in women

Finding the cause is the key to treatment: without the right diagnosis, treatment often does not work [1]. More than one cause can be at work at once [5].

Female pattern hair loss is the most common cause in women [3]. It starts as diffuse thinning on top and at the crown, or a widening part, while the front hairline stays [4][6][1]; in some women it is worst at the front, in a triangle or “Christmas tree” shape [4]. It usually begins when a woman is in her 40s, 50s or 60s, sometimes earlier [3]; a UK study found it in 6% of women under 30 and 42% of women over 70 [4]. Women rarely go fully bald, but it keeps progressing without treatment [3]. Doctors grade it on scales such as Ludwig’s or Sinclair’s [4].
Shedding after a trigger (telogen effluvium). Losing 50 to 100 hairs a day is normal; much more is telogen effluvium [2]. It follows a trigger by a few months: giving birth, a high fever or illness, an operation, losing 20 pounds or more, a lot of stress, or stopping the pill [2]. After childbirth it often starts about 2 months later and peaks at about 4 months [2]. Once the trigger is over, hair tends to regain its fullness within 6 to 9 months; ongoing stress can keep the shedding going [2]. It can come on top of pattern hair loss [5].
PCOS and other hormone causes. Polycystic ovary syndrome is a common cause of a hormonal imbalance that thins the hair, alongside irregular periods, extra facial or body hair, acne and weight gain; stopping some birth control pills can cause a temporary imbalance too [1][9]. More in PCOS and hair loss below.
Thyroid disease. A thyroid problem can thin the hair, and some people see it come out in clumps when they brush; treating the thyroid can reverse it [1].
Too little iron, protein, zinc or biotin can cause noticeable hair loss, and hair can regrow once the body gets enough [1]. Doctors often check ferritin (the body’s iron store), although its link with pattern hair loss is disputed [4].
Tight hairstyles (traction alopecia). Hair worn tightly pulled back, for a long time, thins first at the hairline [1][10]. It is especially common in girls and women of African descent [10]. If the pulling goes on, it scars: the skin turns shiny and bald and the hair cannot grow back [10][13].
Alopecia areata causes sharply outlined round or oval bald patches [11][5]. It usually begins in children and young adults but can start at any age; hair may regrow on its own in about a year, and there is no cure, but treatment can help it regrow [11].
Scarring alopecias. Inflammation destroys the follicles, and a destroyed follicle cannot grow hair again, so catching it early matters [1]. Frontal fibrosing alopecia, a form of lichen planopilaris [13], looks like a receding band along the front and sides of the head, is usually diagnosed after menopause, and 80% to 95% of women with it have lost some or all of their eyebrows [12]. Central centrifugal cicatricial alopecia (CCCA) starts at the crown and spreads outward; hair may break, and the scalp may have bumps, feel tender or itch, or show nothing at all [13].
Menopause and age. The NHS lists hair thinning among the symptoms of perimenopause and menopause [14]. With age hair grows more slowly and a woman’s hairline naturally starts to recede [1].
Medication. Some medicines cause hair loss. Ask the doctor who prescribed it, and do not stop on your own [1]. For weight-loss injections, see GLP-1 drugs and hair loss.

What the pattern can point to

A rough guide, not a diagnosis; the sources are in the list above.

What you notice	Often
A wider part, thinner on top, hairline kept	Female pattern hair loss
A lot of hair falling out, a few months after birth, illness, surgery or weight loss	Shedding (telogen effluvium)
Thinning plus irregular periods, acne or extra facial hair	PCOS or another androgen excess
Thinning at the hairline or temples where hair is pulled tight	Traction alopecia
Round or oval bald patches	Alopecia areata
A receding band at the front and thinning eyebrows, often after menopause	Frontal fibrosing alopecia (scarring)
Thinning at the crown with a tender or itchy scalp	Possibly CCCA (scarring)

PCOS and hair loss

Polycystic ovary syndrome (PCOS) affects 10% to 13% of women [7]. In the UK the NHS now calls it polyendocrine metabolic ovarian syndrome (PMOS) [9]. Its main signs include irregular periods, extra facial and body hair or hair loss, weight gain, difficulty getting pregnant, and oily skin and acne [9].

How common is hair loss with PCOS? A 2025 meta-analysis pooled 18 studies of 3,464 women with PCOS (median age 25.5): 22.7% had female pattern hair loss. The other way round, 32.3% of women with female pattern hair loss had PCOS. The authors rate the certainty low and very low, because the studies differ a lot [8]. PCOS is the hormone condition most often found alongside female pattern hair loss [4].

How it is diagnosed. The 2023 international guideline needs two of three: signs or blood tests of too many androgens, irregular ovulation, and polycystic ovaries on an ultrasound, for which an AMH blood test can now stand in [7]. Androgens are measured with total and free testosterone [7]. The pill makes those tests unreliable; if a test is essential, the pill is stopped for at least 3 months, with other contraception [7]. Hair loss alone, without extra body hair, is a weak sign of high androgens [7], and pattern hair loss with normal androgen levels is not a sign of androgen excess [6]. New, severe or quickly worsening signs need tests to rule out an androgen-producing tumour [7]. The guideline asks doctors to take hair loss seriously however mild it looks [7].

Treatment. The combined pill is the guideline’s first drug for irregular periods and androgen excess [7]. For hair loss, an anti-androgen such as spironolactone could be added to the pill, though there is little evidence in women with PCOS [7]; spironolactone at 25 to 100 mg a day appears to carry lower risks of side effects [7]. Anti-androgens can harm the genital development of a male fetus, so women who could get pregnant should use effective contraception [7]. The Androgen Excess and PCOS Society advises starting treatment of female pattern hair loss with 5% minoxidil and adding anti-androgens for severe loss or androgen excess [6]. More: spironolactone and hair loss.

Tests a doctor may do

There is no single hair-loss test. The doctor starts with your history and a look at the scalp, and orders blood tests depending on what they find [4][6]:

Signs of androgen excess: extra body or facial hair, irregular periods, acne, ovarian problems and infertility [4]. The Androgen Excess and PCOS Society says every woman with female pattern hair loss should be assessed for it [6]; the blood tests are total and free testosterone [7].
Iron (ferritin), thyroid hormones, vitamin D, zinc and prolactin: optional but recommended by the same society [6]. Iron deficiency and thyroid problems should be treated before hair-loss treatment starts [5]. Some studies suggest iron treatment when ferritin is 30 μg/l or lower and hair loss is active [4].
If PCOS is suspected: blood tests for hormones and insulin resistance, and an ultrasound of the ovaries (only over 18) [9].
At the scalp: a hair pull test and a magnified look (trichoscopy), which also shows the lost follicle openings of scarring alopecia [5]. A scalp biopsy settles the diagnosis but is usually not needed [4].

Without signs of androgen excess, lab tests are rarely needed for female pattern hair loss [4].

When to see a doctor

Any worry about hair loss is a reason to go; a dermatologist can tell shedding from hair loss, and some people have both [2]. Go soon, ideally to a dermatologist, if:

the hair loss is sudden or comes in patches [15][11]
the scalp hurts, is tender or itches, or the skin looks shiny where hair used to be [5][13][10]
the hairline recedes in a band, or your eyebrows are thinning [12]
you also have irregular periods, acne or new facial or body hair [4][9]
you do not know the reason, or there is no hair loss in your family (the minoxidil label says not to treat yourself then) [15]
treatment has not helped after 6 months, or the hair loss is causing you distress [5]

Scarring types are the reason not to wait: they can cause permanent loss and need early referral [5], and early treatment of frontal fibrosing alopecia can stop it progressing [12].

Treatments

Treat the cause first: iron deficiency and thyroid problems are corrected before hair-loss treatment [5], and shedding after a trigger usually stops on its own [2]. For female pattern hair loss:

Minoxidil on the scalp. FDA-approved for women in 2% and 5% strengths [3]: the 2% since 1991, the once-a-day 5% foam since 2014 [4]. The foam is half a capful once a day on the thinning area; results may show at 3 months, and some women need at least 6 [15]. Reviewers advise at least 12 months before judging [4]. Avoid it when pregnant, trying to get pregnant or breastfeeding [3]. More: how to use minoxidil.
Spironolactone is the most used anti-androgen for female pattern hair loss, off-label [4]. Like the other hair-loss pills it can cause birth defects, so dermatologists recommend birth control for women who have not been through menopause [3]. More: spironolactone and hair loss.
Low-dose oral minoxidil (off-label), 0.25 to 1 mg a day for women [5], improves density; it can cause dizziness on standing, fluid retention and extra hair growth, but at a low dose it is usually well tolerated [4].
Finasteride and dutasteride are only for women who cannot or do not want to become pregnant [13]; they can be used off-label after menopause, with limited evidence [5], and finasteride 1 mg a day for 12 months did not work in postmenopausal women [4]. More: finasteride and DHT blockers.
PRP (injections of your own platelets): a review cited by dermatologists found an effect in 10 of 12 studies, 6 with a statistically significant improvement [13], but how it would work is not completely understood [5].
Laser combs and caps: in sham-controlled trials with 128 men and 141 women over 26 weeks, hair density rose more than with the sham device [13]; studies of laser light overall carry a high risk of bias [4].
A hair transplant may be an option for some women with female pattern hair loss [3]. Who is a candidate: hair transplants for women.

Sources

Source titles and quotes are as published.

[1] Hair loss: Who gets and causes

American Academy of Dermatology (no named author) · American Academy of Dermatology (aad.org), patient information · A patient information page from the American Academy of Dermatology, the US dermatologists' professional body, listing the common causes of hair loss and whether hair can regrow after each. General guidance, not a study; the archived page states no review date.

In women, hereditary hair loss usually first shows as overall thinning or a widening part. “In women, the first noticeable sign of hereditary hair loss is usually overall thinning or a widening part.”
A few months after childbirth, an illness, an operation or a stressful time, many more hairs can come out in the brush or on the pillow. “A few months after giving birth, recovering from an illness, or having an operation, you may notice a lot more hairs in your brush or on your pillow. This can also happen after a stressful time in your life, such as a divorce or death of a loved one.”
PCOS is a common cause of a hormonal imbalance that can thin the hair on the scalp; stopping some birth control pills can cause a temporary imbalance. “A common cause of this imbalance is polycystic ovary syndrome (PCOS). It leads to cysts on a woman’s ovaries, along with other signs and symptoms, which can include hair loss. Stopping some types of birth control pills can cause a temporary hormonal imbalance. Women who develop a hormonal imbalance can develop thinning hair (or hair loss) on their scalp.”
Thyroid problems can thin the hair, and treating the thyroid disease can reverse it. “If you have a problem with your thyroid, you may see thinning hair. Some people notice that their hair comes out in clumps when they brush it. Is regrowth possible? Yes, treating the thyroid disease can reverse the hair loss.”
Too little biotin, iron, protein or zinc can cause noticeable hair loss, and hair can regrow once the body gets enough. “Too little biotin, iron, protein, or zinc If you’re not getting enough of one or more of these, you can have noticeable hair loss. Is regrowth possible? Yes. When your body gets enough of the missing nutrients, hair can regrow.”
Some medications cause hair loss; ask the prescribing doctor and do not stop the medication before talking to them. “If you think a medication is causing your hair loss, ask the doctor who prescribed it if hair loss is a possible side effect. It’s essential that you do not stop taking the medication before talking with your doctor.”
In scarring alopecia, inflammation destroys the follicles, which then cannot grow hair; catching it early can prevent further loss. “This condition develops when inflammation destroys hair follicles. Once destroyed, a hair follicle cannot grow hair. Diverse conditions can cause this. The medical name for this group of conditions is cicatricial alopecia. Is regrowth possible? Once a hair follicle is destroyed, it cannot regrow a hair. Catching this condition early can prevent further hair loss.”
With age hair growth slows and a woman's hairline naturally starts to recede. “With age, most people notice some hair loss because hair growth slows. At some point, hair follicles stop growing hair, which causes the hair on our scalp to thin. Hair also starts to lose its color. A woman’s hairline naturally starts to recede.”
Finding the cause is the key to effective treatment. “While many causes of hair loss can be treated successfully, the key to effective treatment is to find out what’s causing the hair loss. Without an accurate diagnosis, treatment is often ineffective.”
Hair often worn tightly pulled back can be lost for good; this is traction alopecia. “If you often wear your hair tightly pulled back, the continual pulling can lead to permanent hair loss. The medical name for this condition is traction alopecia.”

[2] Do you have hair loss or hair shedding?

American Academy of Dermatology (no named author) · American Academy of Dermatology (aad.org), patient information · A patient information page from the American Academy of Dermatology on the difference between excessive shedding (telogen effluvium) and hair loss. General guidance, not a study; the archived page states no review date.

Shedding 50 to 100 hairs a day is normal; shedding much more is called telogen effluvium. “It’s normal to shed between 50 and 100 hairs a day. When the body sheds significantly more hairs every day, a person has excessive hair shedding. The medical term for this condition is telogen effluvium”
Common triggers: losing 20 pounds or more, giving birth, a lot of stress, a high fever, an operation, an illness, or stopping birth-control pills. “Excessive hair shedding is common in people who have experienced one the following stressors: Lost 20 pounds or more Given birth Experiencing lots of stress (caring for a loved one who is sick, going through a divorce, losing a job) Had high fever Undergone an operation Recovering from an illness, especially if it included high fever Stopped taking birth-control pills”
After childbirth, shedding often starts about 2 months later and peaks at about 4 months; it is normal and temporary. “Most people notice the excessive hair shedding a few months after the stressful event. For example, a new mom can see excessive hair shedding about two months after giving birth. The shedding usually peaks about four months after giving birth. This shedding is normal and temporary.”
Once the shedding stops, hair tends to regain its fullness within 6 to 9 months; ongoing stress can keep it going for a long time. “As your body readjusts, the excessive shedding stops. Within six to nine months, the hair tends to regains its normal fullness. If the stressor stays with you, however, hair shedding can be long lived. People who are constantly under a lot of stress can have long-term excessive hair shedding.”
If you are worried about how much hair is falling out, a dermatologist can help and can tell shedding from hair loss; some people have both. “If you are concerned by the amount of hair falling out, you don’t need to suffer in silence. You can turn to a dermatologist for help. These doctors specialize in diagnosing and treating the skin, hair, and nails. A dermatologist can tell you whether you have hair loss or excessive hair shedding. Some people have both.”

[3] Thinning hair and hair loss: Could it be female pattern hair loss?

American Academy of Dermatology (no named author) · American Academy of Dermatology (aad.org), patient information · A patient information page from the American Academy of Dermatology, the US dermatologists' professional body. General guidance, not a study; the archived page states no review date. Copied from the hair-transplant-women archive (source 3 there, fetched 2026-10-17).

Female pattern hair loss is the most common cause of hair loss in women. “FPHL is actually the most-common cause of hair loss in women.”
It usually begins in a woman's 40s, 50s or 60s, sometimes earlier. “For most women, FPHL begins in midlife, when a woman is in her 40s, 50s, or 60s. It can begin earlier for some women.”
It is progressive, but women rarely go fully bald: the part widens and the temples may recede. “FPHL is a progressive condition. This means women tend to continue losing hair. But women do not lose all of their hair, as do some men. Instead, your part often gets wider. Hair near your temples may recede.”
Other causes can look like female pattern hair loss and need different treatment. “Other common causes of hair loss in women can look a lot like FPHL. Each of these causes requires different treatment.”
Both 2% and 5% minoxidil are FDA-approved for female pattern hair loss. “Products containing either 2% or 5% minoxidil have been approved to treat FPHL.”
Women who are pregnant, planning pregnancy or breastfeeding should avoid minoxidil. “Women who are pregnant, plan to become pregnant, or who are breastfeeding should avoid minoxidil.”
The prescription pills for female pattern hair loss can cause birth defects; dermatologists recommend birth control for all women before menopause who take one. “Pregnancy and hair-loss medications: All of these prescription medications may cause birth defects, so none of these is an option for women who are pregnant or plan to become pregnant. Dermatologists recommend that all pre-menopausal women use birth control while taking one of these prescription medications.”
A hair transplant may be an option for some women with female pattern hair loss. “Hair transplant: Long used to treat hair loss in men, a hair transplant may be an option for some women with FPHL.”

[4] Female pattern hair loss: A clinical, pathophysiologic, and therapeutic review

Fabbrocini G, Cantelli M, Masarà A, Annunziata MC, Marasca C, Cacciapuoti S · International Journal of Women's Dermatology 4(4):203-211, 2018 · A narrative review by dermatologists (University of Naples) of how female pattern hair loss looks, how it is diagnosed and treated. It summarises other work and adds no new patient data. Funding: none; authors declare no competing interests. Copied from the hair-transplant-women archive (source 2 there).

The usual first sign is diffuse thinning on top and at the crown, with the front hairline kept. “The first manifestation is the diffuse thinning of the upper biparietal and vertex regions and preservation of the anterior hair implantation line.”
Another pattern is thinning that is worse at the front, in a triangle or Christmas-tree shape. “Another manifestation is the thinning of the upper bitemporal region and vertex with frontal accentuation that configures as a triangular or Christmas tree form”
Several scales grade it, among them Ludwig's and Sinclair's. “There are several hair loss scales that attempt to categorize FPHL and each has advantages and disadvantages (Ludwig, 1977, Ramos and Miot, 2015, Savin, 1994, Yip and Sinclair, 2006;”
In the UK it was found in 6% of women under 30 and 42% of women over 70. “In the United Kingdom, 6% of women younger than age 30 years have FPHL for women older than 70 years, FPHL reaches a rate of 42%”
PCOS is the hormone condition most often found alongside female pattern hair loss. “The most common endocrinologic comorbidity that is associated with FPHL is polycystic ovarian syndrome”
Heavy shedding with little loss of volume on top points to telogen effluvium, acute or chronic. “Women with increased hair shedding but little or no reduction in hair volume over the mid-frontal scalp could be suffering from several diseases and acute and chronic telogen effluvium (TE) should be considered in particular.”
The doctor looks for signs of androgen excess: excess body or facial hair, irregular periods, acne, ovarian problems and infertility. “A history and physical examination should aim at detecting signs of hyperandrogenism such as hirsutism, ovarian abnormalities, menstrual irregularities, acne, and infertility.”
Without such signs, lab tests are rarely needed for female pattern hair loss. “Laboratory test results are rarely evaluated in women who suffer from FPHL with no signs of hyperandrogenism.”
A scalp biopsy settles the diagnosis but is usually not needed. “Testing a scalp biopsy is diagnostic but usually not required.”
The link between low ferritin and female pattern hair loss is disputed. “An association between ferritin levels and FPHL is controversial.”
Some studies suggest iron treatment when ferritin is 30 μg/l or lower and hair loss is active. “some studies suggest that with a serum ferritin level of ≤ 30 μg/l and active hair loss, patients should be treated with iron therapy.”
The FDA approved 2% minoxidil for women in 1991 and the once-daily 5% foam in 2014. “In FPHL, 2% minoxidil was approved by the FDA in 1991 and a 5% minoxidil foam with once daily application was approved in 2014”
Use it for at least 12 months before judging whether it works (2% solution twice a day, 5% foam once a day). “The topical minoxidil 2% solution should be applied only to the affected area of the scalp at 1 ml twice daily (once daily for the minoxidil 5% foam) for a minimum period of 12 months before determining the efficacy.”
Spironolactone is the most used anti-androgen for female pattern hair loss, off-label. “Spironolactone is the most commonly used, off-label anti-androgen for the treatment of female AGA and hirsutism.”
Off-label oral minoxidil improves density but can cause dizziness on standing, fluid retention and extra hair growth. “Off-label use of oral minoxidil is known to improve hair density in the treated patients but could be complicated by postural hypotension, fluid retention, and hypertrichosis.”
At a low dose it is usually well tolerated, and an option for women who cannot or will not use the topical form. “Low-dose oral minoxidil is usually well tolerated in the majority of patients with FPHL and a reasonable alternative in women who are intolerant of or unwilling to use topical minoxidil”
Finasteride 1 mg a day for 12 months did not work in postmenopausal women. “proved the ineffectiveness of finasteride 1 mg/day taken for 12 months in postmenopausal women with AGA.”
Studies of laser light therapy carry a high risk of bias. “Many research studies started investigations into the efficacy of LLLT for AGA in men and women but the power of the device together with no standardization of study methods resulted in a high risk of bias.”

[5] Male and female pattern hair loss

Iyengar L, Li J · Australian Prescriber 48(3), 2025 · A practical review for prescribers in Australia (University of Melbourne authors) of diagnosis, other causes to rule out, treatment and when to refer. One author reports payments from Bristol Myers Squibb and CeraVe. Copied from the spironolactone archive (source 15 there).

Telogen effluvium is sudden hair loss after pregnancy or a severe psychological or physical stress. “For example, telogen effluvium presents as abrupt hair loss following pregnancy or a severe psychological or physical stressor.”
Alopecia areata shows as sharply outlined patches. “Alopecia areata presents as well-circumscribed patches of hair loss in adults or children”
Pattern hair loss and telogen effluvium can happen at the same time. “AGA can present simultaneously with other forms of hair loss, such as telogen effluvium.”
A hair pull test and a magnified look at the scalp (trichoscopy) help diagnose pattern hair loss. “The hair pull test and dermoscopy of the scalp (also known as trichoscopy) can assist in the clinical diagnosis of AGA.”
Scarring alopecias need early referral to a dermatologist because they can cause permanent loss. “It is important that the primary care physician is able to identify scarring alopecias to allow early referral to a dermatologist for treatment, as these can lead to permanent hair loss.”
In scarring alopecia the follicle openings disappear, which trichoscopy shows best. “The key finding in scarring alopecia is the loss of follicular ostia which is best determined on trichoscopy.”
Iron deficiency and thyroid problems must be treated before starting hair-loss treatment. “nutritional deficiencies such as iron deficiency, or metabolic disorders such as thyroid dysfunction, must be treated prior to starting treatment for hair loss.”
Low-dose oral minoxidil for women: 0.25 to 1 mg once a day. “Sublingual or oral minoxidil 0.25 to 1 mg tablets (compounded): take orally once daily.”
It can cause dizziness on standing, fluid retention and extra hair growth. “Sublingual or oral minoxidil may cause postural hypotension, fluid retention and hypertrichosis.”
Finasteride and dutasteride can be used off-label after menopause, with limited evidence, and are generally not recommended before menopause because of the risk to a male fetus. “5-alpha-reductase inhibitors can be used off label in postmenopausal women; however, evidence for its use is limited. This treatment is generally not recommended in premenopausal women due to the risk of feminisation of the male fetus.”
How PRP would work on hair is not completely understood. “Although not completely understood, platelet-rich plasma is believed to have a therapeutic effect on hair loss”
See a dermatologist if the diagnosis is unclear, scarring is suspected, treatment has not helped after 6 months, the hair loss causes distress, or there is pain or discomfort. “Referral to a dermatologist should be considered if the diagnosis is unclear, scarring alopecia is suspected, patients do not respond after 6 months of active pharmacological treatment, there is psychological distress due to hair loss, or if there are concomitant symptoms such as pain or discomfort.”

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

Carmina E, Azziz R, Bergfeld W, Escobar-Morreale HF, Futterweit W, Huddleston H, Lobo R, Olsen E · Journal of Clinical Endocrinology & Metabolism 104(7):2875-2891, 2019 · Recommendations from an expert task force of the Androgen Excess and PCOS Society (dermatology, endocrinology, reproductive endocrinology), based on studies published to 2017. Expert opinion with graded evidence, not new data. PubMed abstract read; copied from the spironolactone archive (source 13 there).

In female pattern hair loss the front hairline is generally kept. “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.”
Female pattern hair loss on its own is not a sign of androgen excess when androgen levels are normal. “Isolated FPHL should not be considered a sign of hyperandrogenism when androgen levels are normal.”
Every woman with female pattern hair loss should be checked for androgen excess; vitamin D, iron, zinc, thyroid hormones and prolactin are optional but recommended. “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.”
Treatment should start with 5% minoxidil, adding finasteride-type drugs or anti-androgens for severe loss or androgen excess. “Treatment of FPHL should start with minoxidil (5%), adding 5α-reductase inhibitors or antiandrogens when there is severe hair loss or hyperandrogenism.”
Assessing female pattern hair loss is mainly a matter of history and examination. “The assessment of patients with FPHL is primarily clinical.”

[7] Recommendations From the 2023 International Evidence-based Guideline for the Assessment and Management of Polycystic Ovary Syndrome

Teede HJ, Tay CT, Laven JJE, Dokras A, Moran LJ, Piltonen TT, Costello MF, Boivin J, et al. · Journal of Clinical Endocrinology & Metabolism 108(10):2447, 2023 · The summary of the international PCOS guideline, led by Monash University with 39 professional and consumer organisations from 71 countries and approved by Australia's NHMRC. Recommendations are graded by evidence; several on hair loss are consensus or practice points because evidence in PCOS is limited. Several authors declare pharmaceutical consulting fees, listed in the paper. Full text read.

PCOS affects 10% to 13% of women. “PCOS prevalence is between 10% to 13% as confirmed in the guideline process”
Diagnosis needs two of three: androgen excess (signs or blood test), irregular or absent ovulation, polycystic ovaries on ultrasound, where an AMH blood test can now replace the ultrasound. “This requires the presence of two of the following: i) clinical/biochemical hyperandrogenism; ii) ovulatory dysfunction; and iii) polycystic ovaries on ultrasound; and here in 2023, alternatively anti-Müllerian hormone (AMH) can now be used instead of ultrasound.”
Androgen excess is measured with total and free testosterone. “Healthcare professionals should use total and free testosterone to assess biochemical hyperandrogenism in the diagnosis of PCOS”
The pill makes androgen tests unreliable; if testing is essential it should be stopped for at least 3 months, with other contraception. “It is very difficult to reliably assess for biochemical hyperandrogenism in women on the combined oral contraceptive pill (COCP) as the pill increases sex hormone-binding globulin and reduces gonadotrophin-dependent androgen production. If already on the COCP and assessment of biochemical androgens is imperative, the pill should be withdrawn for a minimum of 3 months and contraception should be managed otherwise during this time.”
Female pattern hair loss without excess body hair is a weak predictor of high androgens. “Healthcare professionals could recognize that female pattern hair loss and acne in isolation (without hirsutism) are relatively weak predictors of biochemical hyperandrogenism.”
Doctors should take hair loss seriously, whatever its apparent severity. “should consider the reporting of unwanted excess hair growth and/or female pattern hair loss as being important, regardless of apparent clinical severity.”
New, severe or worsening androgen excess needs tests to rule out an androgen-secreting tumour. “Note that new-onset severe or worsening hyperandrogenism, including hirsutism, requires further investigation to rule out androgen-secreting tumours and ovarian hyperthecosis.”
The combined pill is the first-line drug for irregular periods and androgen excess in PCOS. “Combined oral contraceptive pills are the first line pharmacological treatment for menstrual irregularity and hyperandrogenism”
For female pattern hair loss, an anti-androgen together with the pill could be tried, though there is little evidence in PCOS. “Given the negative psychological impact of female pattern hair loss, anti-androgens in combination with COCP could be trialled, acknowledging the lack of evidence in the PCOS population.”
Anti-androgens can harm the genital development of a male fetus, so women who can get pregnant should use effective contraception. “regarding the risks of incomplete development of external genital structures of male foetuses (undervirilization) when anti-androgens are used. To prevent this, women who can get pregnant should be strongly counselled to use effective contraception (eg, intrauterine device or COCPs).”
Spironolactone at 25 to 100 mg a day appears to carry lower risks of side effects. “Spironolactone at 25-100 mg/day appears to have lower risks of adverse effects.”

[8] Bi-directional association between female pattern hair loss and polycystic ovary syndrome: A systematic review and meta-analysis

Rayner DG, McMullen E, Mundle K, Pham M, Sibbald C, Donovan J · JAAD International 23:24, 2025 · A systematic review and meta-analysis (research letter) pooling published studies in both directions: hair loss in women with PCOS, and PCOS in women with hair loss. The authors rate the certainty low to very low because the studies disagree a lot. Funding: none; no relevant conflicts declared.

Across 18 studies of 3,464 women with PCOS (median age 25.5), 22.7% had female pattern hair loss (interval 16.9% to 29.7%, low certainty). “Eighteen studies reporting on 3464 patients (median age: 25.5 years) assessed the prevalence of FPHL in patients with PCOS. The pooled prevalence of FPHL in patients with PCOS was 22.7% (16.9%-29.7%; Fig 2 ; low certainty, due to very serious inconsistency).”
The other way round, 32.3% of women with female pattern hair loss had PCOS (interval 13.6% to 59.1%, very low certainty). “The pooled prevalence of PCOS in patients with FPHL was 32.3% (13.6%-59.1%”

[9] Polyendocrine metabolic ovarian syndrome (PMOS)

NHS (no named author) · NHS website (nhs.uk), health A to Z · The UK National Health Service's patient page on PCOS, which the NHS now calls PMOS. General guidance, not a study.

The NHS now calls PCOS polyendocrine metabolic ovarian syndrome (PMOS). “PMOS used to be called polycystic ovary syndrome (PCOS).”
Its main symptoms include irregular periods, excess hair growth or hair loss, weight gain, difficulty getting pregnant, and oily skin and acne. “The main symptoms of PMOS include: irregular periods or long gaps between your periods excessive hair growth (hirsutism) or hair loss weight gain or difficulty losing weight difficulty getting pregnant mental health problems, such as depression or anxiety oily skin and acne”
Tests include blood tests for hormones and insulin resistance, and an ovary ultrasound (only over 18). “blood tests to check hormone levels and insulin resistance an ultrasound scan to look at your ovaries An ultrasound scan will only be done if you are over 18 years old.”

[10] Hairstyles that pull can cause hair loss

American Academy of Dermatology (no named author) · American Academy of Dermatology (aad.org), patient information · A patient information page from the American Academy of Dermatology on traction alopecia. General guidance, not a study; the archived page states no review date.

Traction alopecia often shows first at the hairline. “Your hairline is one of the first places you can see traction alopecia.”
It is especially common in girls and women of African descent, where tight styles are common. “Some people experience traction alopecia more often than others because tight hairstyles are common in their culture or profession. This is especially true for girls and women of African descent.”
If the pulling continues, the skin turns shiny and bald and the hair cannot grow back. “When the pulling continues, most people eventually notice that their hair stops growing. Where you once had hair, you’ll see shiny, bald skin. When traction alopecia advances to this stage, your hair cannot grow back.”

[11] Alopecia areata: Overview

American Academy of Dermatology (no named author) · American Academy of Dermatology (aad.org), patient information · A patient information page from the American Academy of Dermatology on alopecia areata. General guidance, not a study; the archived page states no review date.

Alopecia areata often starts with a round or oval bald patch. “This type of hair loss often begins with a round or oval bald patch on the scalp or beard, which may be small and hidden or noticeable.”
It usually begins in children and young adults but can start at any age. “This type of hair loss usually begins in children and young adults, but it can start at any age.”
Hair may regrow on its own in about a year. “Hair may regrow on its own in about a year, and some people never have another episode of hair loss.”
There is no cure, but treatment can help hair regrow. “At this time, alopecia areata cannot be cured. However, treatment can help people regrow their hair.”

[12] Hair loss types: Frontal fibrosing alopecia overview

American Academy of Dermatology (no named author) · American Academy of Dermatology (aad.org), patient information · A patient information page from the American Academy of Dermatology on frontal fibrosing alopecia. General guidance, not a study; the archived page states no review date.

Frontal fibrosing alopecia destroys the follicles and causes permanent hair loss; early treatment can stop it progressing. “It destroys the hair follicles (openings from which hair grows), causing permanent hair loss. With an early diagnosis and medical treatment from a board-certified dermatologist, it’s possible to stop the disease from progressing and causing further permanent hair loss.”
It often looks like a receding hairline along the front and sides of the head. “This type of hair loss often looks like a receding hairline that runs along the front and sides of your head.”
It is usually diagnosed after menopause, mostly 2 to 12 years after it starts. “FFA is usually diagnosed in women after menopause (have not had a period for at least one year). Most notice hair loss about two to 12 years after they start menopause.”
80% to 95% of women with it have lost some or all of their eyebrows. “Between 80% and 95% of women diagnosed with FFA have lost some (or all) of their eyebrows.”

[13] Current and emerging treatment strategies for hair loss in women of color

Okereke UR, Simmons A, Callender VD · International Journal of Women's Dermatology 5(1):37-45, 2019 · A narrative review by US dermatologists (Callender Dermatology) of hair loss types in women of color and their medical and surgical treatment. It summarises other work; no new patient data. Authors declare no conflicts of interest. Copied from the hair-transplant-women archive (source 6 there).

Traction alopecia ends in scarring if the pulling hairstyle continues. “TA begins with folliculitis, and ends with scarring alopecia if a traction-prone hair style is continued.”
Central centrifugal cicatricial alopecia (CCCA) is a scarring alopecia that starts at the crown and spreads outward. “CCCA is a common and progressive form of lymphocyte predominant scarring alopecia that starts at the crown or vertex scalp, and spreads in a peripheral or centrifugal pattern”
Its signs can include breakage, bumps, tenderness or itch of the scalp, or none at all. “There is a range of signs and symptoms associated with CCCA, including the presence of hair breakage (Callender et al., 2012), papules, pustules, tenderness or pruritus of the scalp, or no symptoms at all”
Frontal fibrosing alopecia is a form of lichen planopilaris that affects the front hairline and often the eyebrows. “Frontal fibrosing alopecia (FFA) is a variant of lichen planopilaris that affects the frontoparietal hairline, and often the eyebrows”
Finasteride and dutasteride should only be prescribed to women who cannot or do not want to become pregnant. “To prevent teratogenic effects, finasteride and dutasteride should only be prescribed to women who cannot or do not want to become pregnant.”
A review the authors cite found PRP effective in 10 of 12 studies, 6 with a statistically significant improvement. “Alves and Grimalt (2018) report that PRP has demonstrated therapeutic effectiveness for androgenetic alopecia (AGA) in 10 of 12 studies, with 6 studies demonstrating a statistically significant improvement after treatment with PRP”
In sham-controlled trials of a laser comb (128 men, 141 women, 26 weeks), hair density rose more than with the sham device. “a total of 128 male and 141 female subjects were randomized to receive either a laser comb or sham device in concealed sealed packets, and treated on the entire scalp three times per week for 26 weeks (Jimenez et al., 2014). After 26 weeks, a statistically significant increase in terminal hair density was observed in subjects using the laser comb treatment compared with the sham device.”

[14] Symptoms of menopause and perimenopause

NHS (no named author) · NHS website (nhs.uk), health A to Z · The UK National Health Service's patient page on menopause symptoms. General guidance, not a study.

The NHS lists hair thinning or hair loss among the symptoms of perimenopause and menopause. “Menopause and perimenopause may affect you in other ways, including: a faster, slower or more noticeable heartbeat (palpitations) weakening bones (loss of bone density), which can lead to osteoporosis feeling the need to pee more or not being able to control when you pee ( urinary incontinence ) headaches and migraines that are worse than usual muscle aches and joint pains hair thinning or hair loss”

[15] WOMEN'S Rogaine Unscented (minoxidil 5% topical foam): Drug Facts label

Kenvue Brands / Johnson & Johnson Consumer Inc. · DailyMed (US National Library of Medicine), label version 6, effective Nov 2024, 2024 · The US over-the-counter Drug Facts label of the brand-name 5% minoxidil foam for women. A label states approved use and warnings; it is not a study. Made by the manufacturer. Copied from the hair-transplant-women archive (source 14 there).

The label says not to use it if there is no family history of hair loss, the loss is sudden or patchy, it came with childbirth, or you do not know the reason. “you have no family history of hair loss your hair loss is sudden and/or patchy your hair loss is associated with childbirth you do not know the reason for your hair loss”
Half a capful once a day on the thinning area. “apply half a capful once daily directly to the scalp in the hair loss area”
Results may show at 3 months; some women need at least 6 months. “Results may occur at 3 months with once daily use. For some women, you may need to use this product once a day for at least 6 months before you see results.”
It may be harmful in pregnancy or while breastfeeding. “May be harmful if used when pregnant or breast-feeding.”

How this page was made

We read each source (in full where it is open access; for the Androgen Excess and PCOS Society report, its abstract), archived the text and quote it word for word: a build check fails if any quote is not in the archived text. The sentences on this page are our short summaries; the quotes under each source show exactly what it says. This page has no reddit data. Sources checked October 2026. This is not medical advice: tests and prescription treatments are for you and your doctor.

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