Androgenetic Alopecia Case Report: A 57-Year-Old Woman With Diffuse Hair Loss in Katy & Houston, Texas
Patient Presentation
A 57-year-old female presented as a new patient to our hair loss clinic with concerns of diffuse scalp hair thinning. She reported gradual, moderate hair loss that had been progressing over the past four years. The hair loss was non-scarring and involved the entire scalp. She denied acute shedding episodes but noted a steady decrease in hair density over time.
Family history was notable for hair loss in her brother, suggesting a possible genetic component. The patient is currently on hormone replacement therapy (HRT) and had undergone extensive prior medical evaluation.
Medical Workup
Previous laboratory testing was unremarkable except for elevated ferritin levels. She had been evaluated by hematology, including MRI imaging and additional workup, all of which were negative for underlying systemic disease. She was counseled on transitioning to an anti-inflammatory diet and advised to follow up for ferritin re-evaluation.
Clinical Examination
A comprehensive dermatologic examination was performed, including scalp and hair inspection using dermatoscopy. The patient appeared well developed, well nourished, and in no acute distress.
Key exam findings included:
Diffuse non-scarring hair thinning of the scalp
Findings clinically consistent with androgenetic alopecia (AGA)
Positive hair pull test, supporting active hair shedding
Given the chronicity and pattern of hair loss, the clinical impression favored patterned hair loss with diffuse non-scarring alopecia (L64.8). A punch biopsy was discussed as an option to further confirm the diagnosis.
Diagnosis
Androgenetic Alopecia (Female Pattern Hair Loss)
Female pattern hair loss is a genetically influenced, slowly progressive condition characterized by diffuse thinning, widening of the midline part, and preservation of the frontal hairline.
Treatment Discussion
An extensive discussion was held reviewing both medical and procedural treatment options for female hair loss, including:
Oral minoxidil
Finasteride and dutasteride (appropriate for post-menopausal women)
Spironolactone
Topical minoxidil (Rogaine)
Low-level laser therapy
Nutritional supplements (Nutrafol, Viviscal, Votesse)
Platelet-rich plasma (PRP) therapy
AlmaTED regenerative hair therapy
Hair transplantation
The patient was counseled that procedural treatments such as PRP and AlmaTED are considered cosmetic and not covered by insurance. Risks, benefits, expectations, and timelines for improvement were reviewed in detail.
Selected Treatment Plan
After shared decision-making, the patient elected to proceed with oral medical therapy, including:
Oral Minoxidil 1.25 mg daily (½ of a 2.5 mg tablet)
Finasteride 5 mg daily
Medication Counseling
Oral Minoxidil:
Potential side effects discussed included fluid retention, ankle swelling, dizziness, low blood pressure, shortness of breath, unwanted hair growth, and allergic reactions. The patient was advised that temporary shedding during the first 8–10 weeks is common.
Finasteride:
Risks including low libido, breast tenderness, mood changes, and depression were reviewed. The teratogenic nature of finasteride was emphasized, although the patient is post-menopausal.
All questions were addressed, and the patient demonstrated understanding of medication use and potential adverse effects.
Follow-Up
The patient will return in 3 months for reassessment of hair density, shedding, and treatment response. Additional therapies may be considered based on progress.
