55-Year-Old Female With Chronic Hair Thinning — Androgenetic Alopecia With Telogen Effluvium & PRP Treatment
Hair loss in women is multi-factorial and often worsens over time without targeted intervention. At Reena Jogi MD Dermatology in Katy and Houston, Texas, many women present with chronic thinning, post-partum shedding, post-COVID hair loss, or stress-triggered shedding. This case highlights a 55-year-old woman experiencing years of progressive diffuse thinning and newly starting treatment after prior attempts with topical agents.
Patient Presentation
A 55-year-old established female patient presented for evaluation of generalized scalp hair loss that has gradually worsened over 5–6 years. Her history included:
No scalp symptoms
Prior trials of topical minoxidil and hair, skin & nails supplements with minimal improvement
Recently started Nutrafol
Hair loss began after childbirth, then worsened significantly during COVID and periods of high stress
No recent bloodwork
Current hormone replacement therapy (HRT)
She denied itching, burning, or inflammation. No current treatment regimen was in place at the time of the visit.
Clinical Examination
A scalp examination revealed:
➤ Diffuse thinning consistent with Androgenetic Alopecia (AGA)
Female-pattern thinning
Preserved frontal hairline
Widened midline part
Progressive, slow miniaturization of follicles
➤ Signs of Telogen Effluvium (TE)
History of postpartum shedding
Exacerbation after stress and COVID
Chronic shedding pattern overlaying AGA
Together, these findings point toward longstanding AGA with superimposed chronic TE, a common combination in midlife women.
Diagnosis
Androgenetic Alopecia (L64.8)
Female-pattern thinning driven by genetics and hormonal sensitivity.
Telogen Effluvium (L65.0)
Diffuse shedding triggered by stress, childbirth, hormonal shifts, and illness.
This dual diagnosis explains both the chronic thinning and the episodic worsening.
Treatment Discussion & Plan
A comprehensive review of treatment options was provided, including:
1. Oral Therapies
Dutasteride 0.5 mg daily
Strong 5-alpha-reductase inhibitor
Beneficial for women on HRT or post-menopause
Side effects reviewed: mood changes, breast tenderness, hormonal effects
Oral Minoxidil 1.25 mg daily (½ of a 2.5 mg tablet)
Useful for women who do not tolerate or respond to topical minoxidil
Risks reviewed: swelling, dizziness, low blood pressure, palpitations, rare pericardial effusion
Patient agreed to start low dose
2. Topical Therapy
Ketoconazole 2% shampoo
Reduces scalp inflammation
Supports improved scalp environment
To be used 2–3× per week, leave on 5–10 minutes
3. Supplements
Continue Nutrafol, which she recently initiated
Could also consider Viviscal or Votesse, but patient preferred to stay on current supplement
4. Procedural Therapy
⭐ Platelet-Rich Plasma (PRP) — Treatment #1 Performed
7 cc PRP injected into scalp
Excellent option for AGA
Stimulates follicular activity
No complications during procedure
5. Additional Options Reviewed
AlmaTED hair restoration
Low-level laser therapy (Revian, Theradome)
Hair transplantation (future consideration)
6. Baseline Laboratory Workup
Recommended to evaluate for metabolic or hormonal contributors
Especially important in chronic or postpartum-related hair loss
Treatment Regimen Provided
Dutasteride 0.5 mg orally once daily
Oral Minoxidil 1.25 mg (½ tablet) once daily
Ketoconazole 2% shampoo 2–3× weekly
Continue Nutrafol
PRP performed today
AGA educational handout provided
Follow-up is scheduled in 6 months to evaluate regrowth progress and determine if additional PRP treatments are recommended.
Prognosis
Women with AGA + TE often experience the best results when combining:
Oral medications
Scalp therapy
Supplements
Procedural interventions like PRP
Improvement typically becomes noticeable at 3–6 months, with maximal change at 9–12 months. Given her chronic history and recent initiation of a comprehensive plan, the patient has a favorable prognosis for improved density and reduced shedding.
