Androgenetic Alopecia in a 40-Year-Old Woman — PRP Recommended After Limited Response to Topical Therapy
Androgenetic alopecia (AGA) is the most common cause of progressive thinning in women, often leading to widening of the part, reduced hair density, and gradual loss of volume. At Reena Jogi MD in Katy and Houston, Texas, we see many women who have tried various over-the-counter products without meaningful results and are ready for more advanced treatment options.
This case highlights a 40-year-old woman with long-standing diffuse thinning whose hair loss pattern and treatment preferences guided a customized approach focusing on natural, non-systemic therapies like platelet-rich plasma (PRP).
Patient Background
A 40-year-old female presented as a new patient with a 5-year history of generalized, gradually progressive hair thinning. She described the severity as moderate and noted that her hair loss has slowly worsened over time.
Previous Treatments
OTC hair loss products
Nutritional supplements including Nutrafol
Topical minoxidil
Despite consistent use, she reported little to no improvement with these therapies.
Medical Preferences
The patient strongly preferred non-systemic, non-pharmaceutical options and wished to avoid oral medications.
Clinical Examination
A detailed exam included:
Scalp and hair assessment
Facial and head evaluation
Inspection of upper extremities
Dermatoscopic scalp imaging
Findings
Central thinning with a widened midline part
Pattern consistent with androgenetic alopecia
Diffuse, non-scarring hair loss
Mild seborrheic dermatitis on the left occipital scalp
No signs of inflammatory or scarring alopecia
The patient was alert, well-nourished, and in no acute distress.
Diagnosis: Androgenetic Alopecia (Female Pattern Hair Loss)
Her pattern of thinning, response (or lack thereof) to topical treatments, and dermatoscopic findings support a diagnosis of androgenetic alopecia, a condition influenced by genetics and hormonal factors. AGA is chronic and progressive, but numerous treatments can significantly slow or reverse thinning.
Discussion of Treatment Options
We reviewed the full range of AGA management options:
✔ Topical Therapies
Minoxidil (recommended for continued use)
Ketoconazole shampoo (also beneficial for seborrheic dermatitis)
✔ Oral Therapies (declined by patient)
Spironolactone
Finasteride (for postmenopausal or select cases)
✔ Device-Based & Procedural Therapies
PRP therapy (recommended with excellent expected success rate)
Low-level laser therapy
Alma TED ultrasound therapy (a newer alternative for patients uncomfortable with injections)
PRP Discussed in Detail
The patient was a candidate for PRP (Platelet-Rich Plasma) therapy, which offers:
Natural stimulation of follicles using growth factors from the patient’s own blood
Minimal downtime
Quick procedure (≈2 minutes of injection time)
Options for pain control: cooling chiller or nitrous oxide
Commitment recommended:
A series of 5 PRP treatments to evaluate efficacy, followed by long-term maintenance treatments.
The patient elected to return for PRP after consideration.
Additional Conditions Addressed
1. Post-Inflammatory Hyperpigmentation (PIH)
The patient reported facial discoloration and pitted acne scarring.
Currently receiving laser hair removal every 6 weeks
Experienced severe folliculitis 10 years ago but now tolerating treatment well
Recommended deferring topical treatments until after her laser series
Hydroquinone 4% offered as a gentle option
Stronger options (retinol, vitamin C) discussed for future use
2. Mild Seborrheic Dermatitis
Pink-orange, scaly plaques observed on the occipital scalp.
Recommendations:
Ketoconazole shampoo
Use of anti-dandruff shampoos with tar, selenium sulfide, or zinc pyrithione
Education on chronic nature and triggers like stress
Plan & Follow-Up
Continue topical minoxidil
Consider ketoconazole shampoo
Schedule PRP treatment series when ready
Sun protection and post-laser skincare counseling provided
Follow up in 1 year, or sooner if PRP is initiated
Conclusion
This case demonstrates a classic presentation of female pattern hair loss with central thinning and long-term progression. For women who prefer non-oral, evidence-based treatments, PRP therapy offers an effective and natural option with a strong success rate when performed in series.
At Reena Jogi MD in Katy and Houston, Texas, we prioritize individualized care for women experiencing genetic or hormonal hair thinning—ensuring every patient receives guidance that aligns with their lifestyle, comfort level, and long-term goals.
